The use of intraoperative CT-neuronavigation in Wiltse approach. A technical note

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-09-02 DOI:10.3389/fsurg.2024.1433273

Marco Battistelli, Federico Valeri, Manuela D’Ercole, Alessandro Izzo, Alessandro Rapisarda, Filippo Maria Polli, Nicola Montano

{"title":"The use of intraoperative CT-neuronavigation in Wiltse approach. A technical note","authors":"Marco Battistelli, Federico Valeri, Manuela D’Ercole, Alessandro Izzo, Alessandro Rapisarda, Filippo Maria Polli, Nicola Montano","doi":"10.3389/fsurg.2024.1433273","DOIUrl":null,"url":null,"abstract":"IntroductionThe paraspinal approach was first introduced in 1968 and later refined by Leon Wiltse to gain access to the lateral interevertebral foraminal region. However, challenges can arise due to unfamiliarity with this approach, unique patient anatomy, or in case of revision surgery, potentially elevating the risk of complications and/or poor outcome.MethodsHere we report on two cases in which the intraoperative Oarm CT neuronavigation was used during a Wiltse approach. Under general anesthesia, the spinous process near the surgical level is exposed through a midline incision. The patient's reference anchor is then attached to the exposed spinous process. Intraoperative CT is acquired and transferred to the Stealth Station S8 Surgical Navigation System (Medtronic). The Wiltse approach is now performed through a paramedian incision under neuronavigation guidance and perfectly tailored to the patient's unique anatomy.ResultsThe first case was a patient harboring a left lumbar intraextraforaminal schwannoma and the second one was a patient with an extraforaminal lumbar disc herniation at the adjacent level of a previous lumbar instrumentation. We were able to easily identify and remove both the lesions minimizing the surgical approach with no complication and optimal clinical outcome.Discussion and ConclusionOur cases demonstrate the feasibility of application of intraoperative O-arm CT-neuronavigation to the Wiltse approach. In our opinion, this technique helps in minimizing the surgical approach and rapidly identifying the lesion of interest. Further studies are needed to address the effective utility and advantages of intraoperative CT-neuronavigation in this specific surgical scenario.","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"18 1","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fsurg.2024.1433273","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

IntroductionThe paraspinal approach was first introduced in 1968 and later refined by Leon Wiltse to gain access to the lateral interevertebral foraminal region. However, challenges can arise due to unfamiliarity with this approach, unique patient anatomy, or in case of revision surgery, potentially elevating the risk of complications and/or poor outcome.MethodsHere we report on two cases in which the intraoperative Oarm CT neuronavigation was used during a Wiltse approach. Under general anesthesia, the spinous process near the surgical level is exposed through a midline incision. The patient's reference anchor is then attached to the exposed spinous process. Intraoperative CT is acquired and transferred to the Stealth Station S8 Surgical Navigation System (Medtronic). The Wiltse approach is now performed through a paramedian incision under neuronavigation guidance and perfectly tailored to the patient's unique anatomy.ResultsThe first case was a patient harboring a left lumbar intraextraforaminal schwannoma and the second one was a patient with an extraforaminal lumbar disc herniation at the adjacent level of a previous lumbar instrumentation. We were able to easily identify and remove both the lesions minimizing the surgical approach with no complication and optimal clinical outcome.Discussion and ConclusionOur cases demonstrate the feasibility of application of intraoperative O-arm CT-neuronavigation to the Wiltse approach. In our opinion, this technique helps in minimizing the surgical approach and rapidly identifying the lesion of interest. Further studies are needed to address the effective utility and advantages of intraoperative CT-neuronavigation in this specific surgical scenario.

查看原文本刊更多论文

在 Wiltse 入路中使用术中 CT 神经导航。技术说明

引言脊柱旁入路于1968年首次提出，后经Leon Wiltse改进，可进入椎间孔外侧区域。然而，由于对该方法不熟悉、患者解剖结构特殊或翻修手术等原因，可能会出现一些挑战，从而潜在地增加了并发症和/或不良结果的风险。在全身麻醉下，通过中线切口暴露手术水平附近的棘突。然后将患者的参考锚连接到暴露的棘突上。获取术中 CT 并将其传输到 Stealth Station S8 手术导航系统（美敦力）。第一个病例是一名患有左腰椎椎间孔内分裂瘤的患者，第二个病例是一名患有椎间孔外腰椎间盘突出症的患者。讨论与结论：我们的病例证明了将术中 O 型臂 CT 神经导航应用于 Wiltse 入路的可行性。我们认为，这项技术有助于最大限度地减少手术入路，并快速确定感兴趣的病灶。我们需要进一步研究术中 CT 神经导航在这种特殊手术情况下的有效实用性和优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.